tbuckley/cabot-search huggingface dataset:
AB0394 DYSLIPIDEMIA IN RHEUMATOID ARTHRITIS PATIENTS
Authors: I. Klymas
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> Patients with rheumatic diseases characterized by a pronounced inflammatory process. Systemic chronic inflammation, which is characteristic of patients with rheumatoid arthritis (RA), determines the high risk of developing metabolic disorders. Most often, patients with RA have disorders of lipid metabolism. <h3>Objectives</h3> To investigate the dystipidemia frequency in RA patients and in the control group without autoimmune and inflammatory diseases. <h3>Methods</h3> Were investigated 126 RA patients (102 women and 24 men, average age 43,82±2,8 years) and 30 subjects (control group) without autoimmune and inflammatory diseases (25 women and 5 men, average age 42,4±2,6 years). RA was diagnosed according to ARA criteria (1987); patients with hepatitis, alcohol abuse, &gt;55 years old were not included. Statistical analysis was performed using program Statistica. The reliability of differences was defined at p &lt;0.05. <h3>Results</h3> The evaluated of lipid metabolism in RA patients and control group are presented in Table 1. In conduct an analysis of lipid metabolism in RA patients and in the control group, a high level of statistical significance p&lt;0.001 was found in the indicators of lipid metabolism in patients with RA compared with those of the examined control group. <h3>Conclusion</h3> Disorders metabolism of lipids have a high prevalence among patients with RA. For the purpose of timely diagnosis of metabolic disorders of lipid metabolism in patients with RA, it is recommended to carry out a laboratory blood test with the determination of lipidogram indicators at least once a year. <h3>REFERENCES:</h3> NIL. <h3>Acknowledgements:</h3> NIL. <h3>Disclosure of Interests</h3> None Declared.
AB0225 WHAT FACTORS INFLUENCE RA PRESENTATION AT DIAGNOSIS?
Authors: D. Di Giuseppe, J. Askling, H. Westerlind
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> Researchers have mostly focused in understanding which factors influence the risk of rheumatoid arthritis (RA) and its progression. However, little is known on the determinants of disease presentation at diagnosis. This is a fundamental prerequisite for studies focusing in understanding disease progression. <h3>Objectives</h3> To estimate the association between demographic and disease related factors and high disease activity (HDA) of RA at diagnosis by a rheumatologist. <h3>Methods</h3> Data from newly diagnosed RA patients between October 2004 and May 2018 from the Epidemiological Investigation of RA study (EIRA) will be included in these analyses. The outcome of interest is high disease activity, defined as having either DAS28 ESR &gt;5.1 or DAS28 CRP&gt;4.6. Patients without an HDA evaluation at baseline (defined as recorded in a visit between 40 days before and 75 days after EIRA inclusion) have been excluded from the analyses. Odds ratios (ORs) and their 95% confidence intervals (CIs) of HDA were estimated through a mixed model with region as random intercept, to account for between regions variations. The association between each of the factors and HDA was first evaluated with a univariate model. Then, only factors with a significant association were included in the multivariable model. Missing values were excluded in the univariate analyses, but included as separated category in the multivariable analysis. <h3>Results</h3> A total of 1665 patients were included in this study, of which 995 (60%) had HDA at diagnosis. In the univariate analyses, young age at diagnosis (50-59 years: OR=0.76 (0.59-1.00)), longer symptoms duration (&gt;365 days: OR= 0.51 (0.37-0.7)), and diagnosis in more recent years (≥2015: OR= 0.66 (0.48-0.9)) were inversely associated with HDA, while being underweight (BMI &lt;18.5: OR= 2.17 (1.04-4.51)), low education (≤9 years: OR= 1.41 (1.09-1.82)), living alone (OR= 1.42 (1.13-1.78)) and being seronegative (OR=1.78 (1.39-2.28)) had higher odds of HDA. Sex, shared epitope, and cigarette smoking were not associated with HDA at diagnosis. In the multivariable analyses, age and education were no longer associated with HDA. <h3>Conclusion</h3> In this study we observed that sex, symptoms duration, calendar time, living alone, serostatus were associated with high disease activity at diagnosis, while age, sex, education, shared epitope, and cigarette smoking were not. <h3>Acknowledgements</h3> This abstract is on behalf of the EIRA group. <h3>Disclosure of Interests</h3> Daniela Di Giuseppe: None declared, Johan Askling Grant/research support from: Agreements between Karolinska Institutet (with JA as PI) and Abbvie, BMS, Eli Lilly, Galapagos, MSD, Pfizer, Roche, Samsung Bioepis, Sanofi, mainly for the national safety monitoring of rheumatology immunomodulators in Sweden (ARTIS), Helga Westerlind: None declared.
AB0101 ABNORMAL KYNURENINE LEVEL CONTRIBUTES TO THE PATHOLOGICAL BONE FEATURES OF ANKYLOSING SPONDYLITIS
Authors: C. Jeon, S. H. Lee, S. Weon, S. H. Choi, T. H. Kim, I. H. Sung, S. Jo
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> Ankylosing spondylitis (AS) exhibits paradoxical bone features typically characterized by new bone formation and systemic bone loss. <h3>Objectives</h3> Although abnormal kynurenine (Kyn), a tryptophan metabolite, has been closely linked to the disease activity of AS, the distinct role of its pathological bone features remains unknown. <h3>Methods</h3> Kynurenine sera level was collected from healthy control (n = 22) and AS (n = 87) patients and measured by ELISA. In the AS group, we analyzed and compared the Kyn level based on mSASSS scores, MMP13, and OCN. Under osteoblast differentiation, the effect of Kyn in AS-osteoprogenitors resulted in cell proliferation, alkaline phosphatase activity, bone mineralization-related alizarin red s (ARS), von kossa (VON), hydroxyapatite (HA) staining, and mRNA expression markers (ALP, RUNX2, OCN, and OPG) for bone formation. TRAP staining was used for osteoclast formation in RANKL-mediated RAW264.7 cells. <h3>Results</h3> Kyn sera level was significantly elevated in the AS group compared to the healthy control group. In addition, Kyn sera level was correlated with mSASSS score (r = 0.03888, p = 0.067), MMP13 (r = 0.0327, p = 0.093), and OCN (r = 0.0436, p = 0.052). During osteoblast differentiation, treatment with Kyn exhibited no difference in cell proliferation and alkaline phosphate (ALP) activity for bone matrix maturation but promoted ARS, VON, and HA staining for bone mineralization. Interestingly, osteoprotegerin (OPG) and OCN expression was augmented in the presence of Kyn treatment during differentiation. In growth medium, Kyn treatment of osteoprogenitors resulted in induction of OPG mRNA, protein expression, and AhR response genes (AhRR, CYP1b1, and TIPARP). Secreted OPG proteins were observed in the supernatant of osteoprogenitors treated with Kyn. Notably, the supernatant addition to osteoclastogenesis interrupted the TRAP-positive osteoclast formation of RANKL-mediated RAW264.7 cells and reduced osteoclast differentiation markers. <h3>Conclusion</h3> Our results revealed that elevated Kyn level increased the bone mineralization of osteoblast differentiation in AS and decreased RANKL-mediated osteoclast differentiation by inducing OPG expression, suggesting a potential therapeutic target where abnormal Kyn level could be involved in pathological bone features of AS. <h3>REFERENCES:</h3> NIL. <h3>Acknowledgements:</h3> NIL. <h3>Disclosure of Interests</h3> None Declared.
AB0414 FACTORS PREDICTING THE INITIATION OF BIOLOGIC DISEASE MODIFYING ANTI-RHEUMATIC DRUGS FOR RHEUMATOID ARTHRITIS WITHIN THE FIRST THREE YEARS OF DIAGNOSIS
Authors: M. Hameed, S. Exarchou, A. Eberhard, A. Sharma, U. Bergström, G. Cagnotto, J. T. Einarsson, C. Turesson
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> Factors related to the use of biologic disease modifying anti-rheumatic drugs (bDMARDs) in rheumatoid arthritis (RA) have varied in prior studies. <h3>Objectives</h3> This study aims to identify characteristics at the time of diagnosis that may be related to the initiation of treatment with bDMARD within the first three years following diagnosis. <h3>Methods</h3> All patients with early RA diagnosed at the outpatient clinics of Skåne University Hospital in 2012-2016 were identified using the local patient administrative system. Diagnoses were validated in a structured review of the medical records. Patients with a confirmed RA diagnosis, aged ≥18 years with symptom duration &lt;12 months at diagnosis, and who fulfilled the 2010 ACR/EULAR and/or the 1987 ACR classification criteria for RA, were included. Patients who started their first bDMARD in a clinical trial were excluded. Data on treatment were obtained from a national quality register, and from complementary case record reviews. Data on comorbidities were retrieved from a regional healthcare register, and data on level of formal education, country of origin and family background from national registers. The relation between characteristics at diagnosis and initiation of bDMARD within the first three years following diagnosis was examined in crude, age-adjusted and multivariable logistic regression models. <h3>Results</h3> Lower age, higher values for joint counts and DAS28-CRP3, and birth outside Europe were statistically significant baseline predictors of bDMARD start within the first 3 years after diagnosis in crude and age-adjusted analyses (Table 1). High level of education and absence of major comorbidities were predictive in crude but not in age-adjusted models. In multivariable logistic regression analysis, lower age (odds ratio (OR) 0.61 per SD; 95 % CI 0.46-0.83) and higher tender joint count (OR 1.56 per SD; 95% CI 1.18-2.10) were the only significant predictors of start of bDMARD ≤ 3 years after diagnosis. <h3>Conclusion</h3> Lower age and higher tender joint count at diagnosis were associated with an increased likelihood of starting bDMARD therapy within the first 3 years in early RA. The impact of age on the subsequent start of bDMARD therapy was not explained by other patient factors. <h3>REFERENCES:</h3> NIL. <h3>Acknowledgements:</h3> NIL. <h3>Disclosure of Interests</h3> Mohaned Hameed Consultant of: Novartis, Sofia Exarchou Consultant of: AbbVie, Amgen, Janssen, Novartis, UCB Pharma, Anna Eberhard: None declared, Ankita Sharma: None declared, Ulf Bergström: None declared, Giovanni Cagnotto: None declared, Jon Thorkell Einarsson: None declared, Carl Turesson Speakers bureau: AbbVie, BMS, Nordic Drugs, Pfizer, Roche, Consultant of: Roche, Grant/research support from: Bristol Myers-Squibb.
AB0130 KYNURENINE PATHWAY CAN BE A POTENTIAL BIOMARKER OF FATIGUE IN PRIMARY SJOGREN’S SYNDROME
Authors: H. W. Park, Y. Park, J. Lee, J. H. Koh, M. J. Kim, S. H. Park, S. K. Kwok
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> Primary Sjogren's syndrome (pSS) is a chronic autoimmune disease with low quality of life caused by various constitutional symptoms and glandular dysfunction. Although fatigue is one of the most frequent symptoms in pSS, its etiology or biomarkers are poorly elucidated. <h3>Objectives</h3> We investigated potential relationship between severity of fatigue and the kynurenine pathway in pSS. <h3>Methods</h3> Clinical data and blood samples of 81 patients were obtained from a prospective cohort for pSS and compared with age- and sex-matched healthy controls (HC). Severity of fatigue was defined according to the fatigue domain scores in the ESSPRI. Potential biomarkers related to the kynurenine pathway were determined using ELISA. <h3>Results</h3> Of the total, 44 patients were defined as the "severe fatigue (ESSPRI fatigue ≥ 5)" group, whereas 37 as the "less fatigue (ESSPRI fatigue &lt; 5)". Serum tryptophan levels in the severe fatigue group were significantly lower while those of kynurenine were higher. Serum interferon gamma, IDO1, and quinolinic acid levels were mostly higher in the less fatigue group. Kynurenine/tryptophan ratios were distinctly higher in the severe fatigue group than both HC and the less fatigue group (p &lt; 0.001). This ratio showed a strong degree of positive correlation (r = 0.624, p &lt; 0.001) with severity of fatigue in pSS while the other markers showed fair degrees of correlation. <h3>Conclusion</h3> Serum markers related to the kynurenine pathway, especially the kynurenine/tryptophan ratio, may be associated with severity of fatigue in pSS. These results can provide guidance for further investigations on fatigue in pSS. <h3>REFERENCES:</h3> NIL. <h3>Acknowledgements:</h3> NIL. <h3>Disclosure of Interests</h3> None Declared.
AB0262 FATIGUE PATTERNS IN DIFFICULT TO TREAT RHEUMATOID ARTHRITIS PATIENTS
Authors: J. P. Otazu Moudelle, D. Freites, M. Rodríguez Laguna, C. Hormigos, M. P. Álvarez Hernandez, A. Madrid García, L. Abasolo, L. León
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> Fatigue study is scarce in D2T RA. The experience of fatigue is multidimensional, implying complex, multicausal pathways. <h3>Objectives</h3> to identify the factors associated with fatigue on its different subscales (Physical, Living, Cognitive and Emotional). <h3>Methods</h3> Cross-sectional study. 22 patients with D2T RA were included; patients were being followed up in the rheumatology outpatient clinic of Hospital Clínico San Carlos, Madrid, Spain. Data were collected between July 2018 and November 2022. All patients met the ACR/EULAR 2010 criteria and they were in treatment with Biological agents (anti-TNF and Non anti-TNF) or Targeted Synthetic DMARDs (jakinibs). Outcome: Difficult to treat Rheumatoid Arthritis Patients (fulfillment of EULAR criteria). Main variable: Fatigue was assessed by the Bristol Rheumatoid Arthritis Fatigue Multidimensional Questionnaire (BRAF-MDQ) and the Bristol Rheumatoid Arthritis Fatigue Numerical Rating Scale (BRAF-NRS). Covariables: Sociodemographic and disease-related variables. Statistical analysis: A descriptive analysis was carried out for the different variables. To identify factors independently associated to BRAF-MDQ and its subscales, multivariable linear regression was applied. Results were expressed as coef with their corresponding 95% CI. A value of p &lt; 0.05 was consider as statistically significant. <h3>Results</h3> A total of 22 (15.38%) patients were found D2T RA, comprising of 11 females (50%) with a mean age of 62.82±13.45 years and mean disease duration of 17.76±8.47 years. RF was positive in 59% of patients. Regarding comorbidities, 32% had dyslipidemia, 28% hypertension, 10% vascular disease, 27% hypothyroidism and 23% depression. The DAS28-ESR mean score of the patients were 4.10 ± 0.67. The factors affecting the global fatigue and its different subscales was evaluated in multivariate analyze <b>Table 1.</b> Our results shows a different correlation structure between disease and treatment factors and the different dimensions of the BRAF-MDQ. Patients who reported high disability scores had more global fatigue, while those with a poor patient global health assessment perceived more physical fatigue. In addition, an association was observed between depression and cognitive fatigue. Male sex and positive RF was associated with less living fatigue. <h3>Conclusion</h3> It is important to evaluate fatigue in a multidimensional perspective, each of the different subscales could be modulated by different factors. The results of our study indicated that disability predicts global fatigue, however, other factors can configure different patterns of fatigue in D2T RA patients, and identify them is key to the approach of this complex symptom. <h3>REFERENCES:</h3> NIL. <h3>Acknowledgements:</h3> NIL. <h3>Disclosure of Interests</h3> None Declared.
AB0421 REAL-WORLD EFFECTIVENESS OF UPADACITINIB IN PATIENTS WITH RHEUMATOID ARTHRITIS
Authors: D. C. Diederik, P. Durez, J. Lenaerts, R. Westhovens, P. Verschueren
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> The Janus Kinase (JAK) inhibitor Upadacitinib (UPA) has shown efficacy in rheumatoid arthritis (RA) in trials, yet real-world evidence is lacking. <h3>Objectives</h3> We aimed to assess short-term effectiveness of UPA for standard of care for RA. <h3>Methods</h3> Data from participants included in the electronic platform "Tool for Administrative Reimbursement Drug Information Sharing" (TARDIS) were analysed. TARDIS collects data from all Belgian RA patients on advanced therapy during submissions of reimbursement requests for drug initiation or prolongation. Patients initiating UPA between 01/11/2020-31/12/2021, ≥18 years and DAS28&gt;3.7 were included. Effectiveness was based on drug retention, proportion of patients achieving remission (DAS-28 &lt;2.6), low disease activity (LDA, DAS-28 ≤3.2), HAQ-DI≤0.25 (HAQ25), HAQ-DI≤0.50 (HAQ50) as well as a clinical meaningful HAQ-DI-decrease (MCID_HAQ) since baseline of 0.22 at the first follow-up moment at 3 months. Sensitivity analyses by 1st, 2nd or 3rd+-line advanced therapy were performed. <h3>Results</h3> From 13 175 patients in TARDIS in the relevant time period, 996 patients on UPA could be included. Table 1 details this population. Of 871 patients with drug information at next follow-up, 783 (90%) continued UPA, and 42 (5%), 22 (3%), and 18 (2%) changed to a TNFi, non-TNFi and other JAKi respectively. In other effectiveness analyses, 705/996 (71%) patients were included. Remission and LDA were reached in 60% (421/705) and 74% (521/705) of patients respectively. HAQ25, HAQ50 and MCID_HAQ were reached in 11% (78/705), 26% (183/705) and 67% (475/705) of patients. Effectiveness slightly decreased with increasing line of therapy (Figure 1). <h3>Conclusion</h3> Most patients continued UPA treatment. UPA improved clinical outcomes after 3 months in patients with moderately to severely active RA in a real-world setting, even in 3<sup>rd</sup> line of advanced therapy. <h3>Acknowledgements</h3> On behalf of the Royal Belgian Society for Rheumatology. AbbVie sponsored the study and contributed to the design. AbbVie participated in the reviewing and approval of the final version. No honoraria or payments were made for authorship. <h3>Disclosure of Interests</h3> None Declared.
AB0458 STEROIDS IN RHEUMATOID ARTHRITIS - TIME FOR REPREAVAL
Authors: N. Prabu, V. Petciappan, G. Anand, A. Kumar, S. Ram
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> The usage of steroids in the management of Rheumatoid Arthritis (RA) has been questioned after the ACR-2021 guidelines while short-term steroid use has been advocated by EULAR-2022.In usual clinical practices steroid has a major role in the management. The adverse events associated with the steroid use is a major limiting factor. <h3>Objectives</h3> To assess the steroid use in routine clinical practice and review the occurrence of Diabetes(T2DM), Hypertension(HTN),Osteoporosis,CoronaryArteryDisease(CAD),Avascular necrosis (AVN), Cataract, Infections. <h3>Methods</h3> All patients diagnosed with RA from 2014 to 2019 with regular follow up of minimum one year duration were taken for analysis. Demographics, weight recordings, steroid prescribed and baseline characteristics were noted.The presence of complications like DM, HTN, cataract, osteoporosis, CAD, AVN,infections before and after steroids were noted. <h3>Results</h3> A total of 967 patients were included in the analysis,826(85.4%) were given steroids and 141 (14.6%) were managed without steroids. The mean age was 53.58 (10.94) yrs the mean disease duration was 4.73 (5.21) for patient with steroids and 6.104 (6.05%) yrs for patients without steroids Patients who were given steroids had increased occurrence of HTN(8.7%), Infections(6%), cataract(5.3%), diabetes(3.6%), osteoporosis(1.2%), AVN(0.8%), CAD(0.7%).In non-steroids group this was 1.4% each in diabetes and infection, 0.7% HTN while 0% in other categories(<b>Table 1</b>).In the 826 patients steroids were stopped in 567 (58.6%) but the risk of HTN(8.2%), Infections(5.46%), cataract(4.9%), DM(4.05%),Osteoporosis(0.8%),AVN(0.7%)and CAD (0.8%) still remained high. <h3>Conclusion</h3> RA patients treated with Steroids have a increased chance of developing HTN, Infection followed by cataract, diabetes, with minimal increase in osteoporosis, CAD and AVN and this persists even after stopping steroids. <h3>Reference</h3> [1]Smolen JS. recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs. Ann Rheum Dis [Internet]. 2023;82. Available from: http://dx.doi.org/10.1136/ard-2022-223356 EULAR <h3>Acknowledgements:</h3> NIL. <h3>Disclosure of Interests</h3> None Declared.
AB0486 LIVER FIBROSIS IN RHEUMATOID ARTHRITIS PATIENTS TREATED WITH METHOTREXATE: HYPOALBUMINEMIA, THE BIOLOGICAL PITFALL
Authors: W. Lahmar, M. Slouma, G. Mohamed, O. Dhrif, N. Abdelli, L. Metoui, R. Dhahri, I. Gharsallah
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> The relationship between hepatic fibrosis and cumulative doses of methotrexate (MTX) in rheumatoid arthritis (RA) patients is an emerging discussion. Hypoalbuminemia is known to be a potential risk factor for toxicity by methotrexate, mainly hematological toxicity and myelosuppression. <h3>Objectives</h3> The aim of our study was to investigate the biological associated factors with liver fibrosis in RA patients treated with MTX. <h3>Methods</h3> It was a cross-sectional study over nine months [April-December 2021], including RA patients under MTX, recruited from the Rheumatology department of Military Hospital. Liver stiffness was assessed by Fibroscan. Fibrosis and significant liver fibrosis were defined as liver stiffness higher than 6 and 8kPa, respectively. Liver enzymes (AST and ALT), alkaline phosphatase (ALP) and albuminemia were measured. Statistical analyses were performed using SPSS. <h3>Results</h3> Sixty-eight patients were included. The mean age was 51.60+11.82 years. The male-to-female ratio was 0.45. The mean disease duration was 8.29 + 6.48 years. The mean weekly intake of methotrexate was 13.76+3.91mg. The mean cumulative dose was 3508.87+3390.48 mg. The mean values of albuminemia were: 35.39 + 5.18 g/L [16.20 – 43.40]; AST 20.50 + 8.32 IU [11-52]; ALT 19.52 + 9.42 IU [5 -46] and ALP: 82.95 + 38.82 IU [10-240] and were all in the normal range. Four patients (6%) had elevated AST and ALP in 4 (6%) cases. Hypoalbuminemia was noted in 34% (n=23) of the cases. Mean liver stiffness was 4.50 + 1.53kPa. Nine patients had fibrosis, and 4 had significant fibrosis. On the univariate study, we found that hypoalbuminemia was associated with liver stiffness (OR=4.941,CI<sub>95%</sub>[1.107–22.057],p=0.034), along with increased ALP (OR=5.002, IC95% [1.086–67.252], p=0.025). We did not find correlation between and liver stiffness and albuminemia (r: -0.132, p=0.665), liver enzymes: AST (r: 0.036, p= 0.335) ALT (0.086, p= 0.476), nor ALP (r:0.111, p= 0.560). <h3>Conclusion</h3> Hypoalbuminemia leads to an increase in unbound MTX. It is this fraction that contribute to the development of liver damage. Along with the biological liver function, a particular attention is then needed to serum albumin when treating RA patients with MTX. <h3>REFERENCES:</h3> NIL. <h3>Acknowledgements:</h3> NIL. <h3>Disclosure of Interests</h3> None Declared.